2004, 09-27 Permit App: BLD-04-07776 Plumbing Reversal89/27/2889 85:17 PM t H7t titan Lunnunl0.H i r.
sn��
lley
Project Address: 9711 E. Mission Ave.
reversal
Owner: Jeff Brodhead
Mailing Address: same
Contractor: owner
Mailing Address: same
rrom. a rr unuuncnu iu.
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use: plumbing
Phone (Daytime Contact): 926-4264
City, State, Zip Code: 99206
License #: N/A Phone #: same
City, State, Zip Code: Spokane Valley, WA 99206
AUTHORIZED SIGNATURE:
This document originally contained
confidential credit card information which
was redacted pursuant to RCW 19.255.010
and the original aL,.unleht destroyed
pursuant to SOS DAN GS2014-030.
SEP 27 2004 15:23
- 7 -77 (�
JEFF BRODHEAD PAGE.01
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
36.00
=
2
URINALS
X
36.00
=
3
TUBS
X
36.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
56.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
36.00
=
6
DISHWASHER
X
56.00
=
7
CLOTHES WASHER
X
56.00
=
8
GARBAGE DISPOSAL
X
38.00
=
9
WATER SOFTENER
X
36.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
36.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
36.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
36.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
1
X
36.00
=
36.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
36.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
36.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, TANKS, BOILERS
X
36.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
36.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
36.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
56.00
=
METHOD OF PAYMENT: GD
0 CASH 0 CHECK Rip. 0 MASTERCARD
RAlultreon •u use,^.
DATE: 9/27/04 EXPIRES: 12/04
SUBTOTAL
56.00
PROCESSING FEE
335.00
TOTAL PERMIT FEE DUE:
341.00
AUTHORIZED SIGNATURE:
This document originally contained
confidential credit card information which
was redacted pursuant to RCW 19.255.010
and the original aL,.unleht destroyed
pursuant to SOS DAN GS2014-030.
SEP 27 2004 15:23
- 7 -77 (�
JEFF BRODHEAD PAGE.01